| NPI | 1962116459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA MELINA RAY Owner 224-285-6006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-04-10 |